Tick bites can prove difficult to diagnose

Bites claims life, cause two others to get sick

September 24, 2008Mid-summer in rural areas is a time when many people are beginning to reap bountiful harvests from their gardens, and wagons loaded with hay can be seen making their way from the fields to the barns. It is also a time that many look forward to all year — wild blackberries are ripening — and thoughts of having blackberry cobblers and jams during the coming winter is enough to coax many out from under the shade trees and into the thickets and fence rows with buckets, hoping to pick their share of the tasty fruit. But this summer, a berry-picking trip proved to be almost deadly for a Crawford County woman.

Esther Schwartz, who lives on a farm near Riddle, just off Carnes Mill Road, found plenty of berries to pick this year and went out several days to fill her bucket. She used an insect repellent with DEET, but still had to remove a few ticks when she got back home each day. Most of the ticks were tiny and hard to see. A few days later, she became ill.

"It started on a Monday — I had a real bad fever and a severe headache," Schwartz, 35, said. "I thought it was the flu, but it didn't get better. On Thursday, I was still sick."

Her parents, Mose and Mary Schwartz, took her to a local doctor who thought she had the flu or a bad sinus infection. She was given a prescription for antibiotics.

"Her temperature came down some after that," Mary said. "So, the antibiotics helped some, but, we know now, it wasn't the right type of antibiotic. She was still weak. Then, on Sunday, her lips were blue and she had gotten even weaker. It was real hard to arouse her and she couldn't answer questions."

"I was just miserable," Esther added. "I couldn't think straight."

Mose and Mary decided to take her to the hospital in Paoli on Sunday afternoon.

"By then, I was in really bad shape," Esther said. "I was so weak I couldn't even breathe very well — I would actually get tired from breathing. In the hospital, I was sedated and a breathing tube was inserted down my throat."

"Her blood pressure and oxygen were dangerously low," Mary added. "She was a sick girl. And they couldn't get her stabilized, so the decision was made to send her to the hospital in New Albany. We stayed with her the whole time and were told to be prepared for the worse."

Esther was flown to Floyd Memorial Hospital and Health Services in a helicopter, but doesn't remember the trip.

"I don't remember anything that happened for 14 days," Esther said. "But they treated me with a broad-spectrum antibiotic, and I slowly began to respond. Finally, after 16 days, I was able to go home. I was still weak, especially the first day at home, but I kept getting better after that, and I'm feeling good now."

Nancy Layton wasn't as lucky. Layton found a tick on her after she and her husband, Owen, mowed grass in a cemetery near their home in Jasper this summer. A few days later, she began feeling bad. Her doctors thought she had a kidney infection and gave her medication for it.

"She was feeling a little better after a couple of days and went ahead with plans to have knee surgery, which had already been scheduled," Owen said. "She was going to have her knee work done on Thursday, and we thought she would be back home on Friday. But she got really sick in the hospital, and by Saturday, she was in ICU and had tubes down her throat to help her breathe."

Doctors at Jewish Hospital in Louisville tried different antibiotics, but Nancy, who was also a diabetic, didn't respond to any of the treatments.

"My daughter and I stayed with her for 13 days," Owen said. "We were sleeping in chairs at the hospital, and finally, we got a recliner, which helped a lot. But every day was hard. I guess it was kind of like a roller coaster — she'd get a little better, then get worse again. She was allergic to one of the antibiotics and her throat broke out in blisters so bad she had to be put in the burn unit. She turned 59 while she was in the hospital.

"They were trying everything to save her, but two days later, she was gone. She passed away in the burn unit. We now know that a tick bite, from a little lone star tick, was to blame. She had Human Monocytic Ehrlichiosis"

Dr. Robert Pinger, director of the Public Health Laboratory at Ball State University in Muncie, said the first case of Ehrlichiosis caused by a lone star tick in Southern Indiana was diagnosed in 1994.

"Since then, there have been 47 cases reported," Pinger said, "and those have been in the southern part of the state. Harrison and Warrick counties lead with eight cases each. But there could be up to 100 cases out there for every case that is actually reported. A lot of people get better and don't return to the doctor. But the number of reported cases go up and down, mainly because the symptoms are so vague."

Ehrlichiosis is characterized by fever, headache, muscle aches, nausea and vomiting. The disease can be serious, but is usually not fatal. Lone star ticks infected with Ehrlichia chaffeenis, the cause of human Ehrlichiosis, have been collected from Warrick, Spencer, Crawford, Perry, Pike, Harrison and Orange counties. The disease can be treated with antibiotics such as tetracycline.

The lone star tick is slightly smaller than the American dog tick but has much longer mouth parts. The female has a single white spot near the center of her back. The males and nymphs are much smaller than the females. All three stages of the tick — larvae, nymphs and adults — are quite active and move quickly. The lone star tick differs from the dog tick in that all three stages will attach to humans.

The immature stages of the lone star tick, sometimes referred to as "turkey ticks," or "deer ticks," will even attach to ground-feeding birds and be carried to distant locations. The distribution of the tick seems to be expanding northward as a result of the strong growth of populations of the white-tailed deer in Indiana.

Adult lone star ticks appear in late March. Their numbers peak in May and June and decline in July. Nymphs appear in April, peak in May and June and can be found throughout the summer. They can also be seen again in late fall.

"Both horses and deer don't groom themselves well," Pinger said. "That makes it easy for the ticks to attach and travel with the host animal."

Pinger took some of his students to O'Bannon Woods recently to study the tick populations there. Several ticks were found and one of those tested positive for Ehrlichiosis.

"There's still no reason to not enjoy the outdoors," he said. "If someone finds a tick on them, remove it immediately. It takes a while for the tick to transmit the disease to its host."

Insect repellents can help keep ticks at bay, but should contain 20 to 25 percent DEET. Permethrin clothing treatment kills ticks but needs to be applied to clothing beforehand and allowed to dry overnight. The treatment is usually effective for up to a week. Another good repellent is Chlorpyrifos (Dursban).

Pinger said some people are now keeping guineafowl, sometimes known as guineas or guinea hens, to control ticks on their property. It is believed that guineafowl will feed on ticks and small insects, yet won't damage gardens or flower beds.

"If you get Rocky Mountain Spotted Fever from a tick, you will be immune for the rest of your life," Pinger said, "but with Ehrlichiosis, you may be immune if you're infected by the exact same strain again, but that's not likely."

Gerald Ramsey, a retired college professor who lives near Marengo, was also bitten by an infected tick this summer.

"I was really sick for a couple of days," Ramsey said. "Years ago, I had jungle fever. This was just as bad. I had a really bad headache, a fever of 103 degrees, no appetite and was nauseous. But I was lucky.

"My doctor, Dr. Andrew Morton in Corydon, diagnosed it almost immediately. He did a blood test, sent it out to a lab, and it came back positive. He treated it with a specific antibiotic. I was real weak for a couple of weeks, but I've fully recuperated now."

Esther Schwartz said she'll be a little more cautious in the future.

"I'm a little afraid to go into the woods again," she said. "That was really scary."